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Saturday, November 10, 2012

Deliberate or not, stigma is a form
of branding or labelling on a person and is often the result of misinformed
stereotyping, naïve attitudinal assumptions, and downright social prejudices
that have the potential to damage or at least hinder recovery efforts from a mental
illness (Whalen, 2006). In the area of
health care, there is societal stigma attached to people known to suffer from mental
illness as evidenced by their visits to or confinement in psychiatric
institutions. Stigma has pernicious effects
on the affected person and indications point to the fact the despite advances in
modern psychiatric treatment, stigmatizing remains a problem in the 21st
century and continues to grow at significant human cost to patients and their
loved ones (Sartorius & Schulze, 2005).

Not wanting to be stigmatized for
seeking medical attention for their mental ailments, affected people oftenprefer not to seek psychological and
psychiatric help, or at least not be seen by society.Being stigmatized as a nut case is the main barrier to seeking better mental health care with
the attendant quality of life for people who have the illness, for their
families, and for their communities. Despite all the modern advances over the
last half century by the neurosciences, by social and psychological sciences,
by research works of behavioral treatment and by public health investigations
the mystery of the brain–barrier appear as impenetrable as ever. The typical symptoms
ofmental derangement manifest in people who have never consulted with a psychiatrist
(Verdoux & Os, 2002). Could the stigma associated with being confined for observation
in a mental hospital or being seen going in and out of a mental hospital create
problems for a person’s prospects in his or her education, social
relationships, and career progression? The empirical evidences appear to
support a resounding “yes” to the question.

Whalen (2006) concluded from his
studies that reducing or forever banishing stigma is among the greatest
challenges facing mental health professionals, practitioners and health organizations.
The current attitude in the literature
on stigma reduction is that education is
the best means of preventing and eliminating discrimination.
Typically, successful educational campaigns have
drawn upon facts and personal experiences. While facts
can give the audience an overarching understanding of
the impact of stigma, the stories of individuals who have
mental illness can serve as a poignant reminder of
the impact not only of the symptoms of mental illness,
but also the negative associations tied to it.

What exactly constitutes the
prejudices behind the societal stigmatization caused by a perception of being
mentally ill? A study conducted by Harding and Zahniser (1994) tabulated the
significant perceptions that comprise the myths behind the stigma as presented
in Table 1and the corresponding facts that belie each myth.A more comprehensive and purposive educational
program may have to be deployed among organizations such as the military with
the view to challenging the common misconceptions and myths behind the stigma
most feared by patients suffered from mental illness. A similar point-by-point rebuttal
than can boost the confidence of concerned people (family, friends and
colleagues of patient, along with the patient) combined with the benefits of
continues contact the patient can help lift whatever debilitating stigma that
is keeping the patient from seeking medical help (Watson & Corrigan, 2001.

Table 1

Eight Myths and Corresponding Realities
about Mental Illness

Myth / Misconception

Facts

1

Once crazy, always crazy.
People won’t get over the condition

Long-term follow-up research
points to the medical fact that even mental patients with the worst types of
schizophrenia and other severe mental illness can lead normal productive
lives after treatment.

2

All persons with mental
illness are alike

Mentally-ill people are as
diverse as any other.To assert that
all mentally-ill people are alike is no different from claiming that all
Hispanics are the same.

3

Severe mental illnesses are
rare, just like lepers

Severe mental distress such
as manic-depression and schizophrenia may account for up to 8% to 10% of the
population.That is about 640,000
people in a metropolitan area the size of Chicago, enough folks to fill
Omaha, Nebraska and Des Moines, Iowa combined.

4

The mentally ill are dangerous,
one step away from a maniacal killing spree

Very, very few people with
mental illness ever murder someone.In
fact, persons with mental illness are usually no more violent than the rest
of the population.

5

The mentally ill can never
survive outside the hospital

The vast majority of persons
with mental illness live personally successful lives in their community.

6

The mentally ill will never
benefit from psychotherapy

Carefully controlled
research has shown that support and rehabilitation has significant impact on
the lives of persons with mental illness

7

The mentally ill are unable
to do anything but the lowest level jobs

Persons with mental illness
perform at all levels of work, just like the rest of the population.

8

Bad parents and poor
upbringing cause severe mental illness

Schizophrenia and the other
severe mental illnesses are biological diseases They are caused by genetic or
other

embryological factors, not
mom and dad

Note. Adapted from
“Empirical Correction of Seven Myths about Schizophrenia with Implications

Stigmatization devalues a
person’s esteem both in their own self-perception and in the eyes of society. Stigma
encapsulates both the bias and discrimination that can have negative economic,
socio-political and psychological repercussion for stigmatized persons (Whalen,
2006).One of the most pernicious and
insidious effects of stigma is the personal health costs behind a
self-preservation effort not to be stigmatized. There is medical aggravation
when people do not seek professional help in treating their mental illness for
fear of acquiring the stigma if discovered (Sartorius & Schulze,
2005).The stigma creates a formidable
psychological barrier to seeking medical help that is readily available to
people impaired by mental illness.

Research has shown that psychological
distress and its psychiatric symptoms that hamper normal living are significantly
treated with a variety of evidence-based practices (EBPs) in the field of
psychiatric health care (Watson & Corrigan, 2001).However, fundamental to the success of any
treatment is a willingness to be treated and that those afflicted must first
actively seek out professional intervention or treatment.Unfortunately, as Whalen (2006), Sartorius
and Schulze (2005) pointed out, apart from medical costs incurred in such
interventions, many people are not prepared to pay the price in terms of social
antipathy and ostracism arising from the stigma associated with being seen
entering and leaving a mental hospital, let alone being known as actually undergoing
psychiatric treatment.Many people opt
not to pursue mental health services because they do not want to be labelled a nut case, nor suffer the societal
prejudice and discrimination behind the label.

Stigma ostracizes people from society
like lepers in the past (See Table 1). The most prevalent attitude is that they
are violent, dangerous and unproductive. Most of the unfounded perceptions are
largely perpetuated by the negative portrayal of mental
illness in television and movies as well as newscasts (CMHA, 2006).
These derisive attitudes influence the behaviour of
mentally ill individuals. They may opt not to talk about
their illness and not pursue treatment for fear of
becoming a social outcast (Crocker, Major, & Steele, 1998; Miller
& Kaiser, 2001). Stigma rears
its ugly face most disquietingly in the workplace. Mentally ill people have been known
to lose their jobs as they experience credibility issues and a
concomitant loss of responsibility. Whalen (2006) indicated in his
paper that 61% of people with mental illnesses
are outside the labor force; 40% to 60% of those
diagnosed with major depression are unemployed; 20% to
35% with anxiety disorder are without work; and 80% to
90% of those diagnosed with schizophrenia are unemployed. He also referred
to an unnamed US survey stating that more than half of employers
were reluctant to hire an applicant with a history of mental illness,
while a quarter would readily dismiss an employee who had failed
to disclose their pre-employment mental illness. Quinn (2009) cited a survey by
Shaw Trust in the UK stating that more than half of employers would not hire
anyone with known mental illness.A
female worker in an engineering firm who was diagnosed with manic depression
was advised by her manager to keep the diagnosis to herselfand out of HR knowledge (Quinn, 2009).

This consistent rejection
is basically what comprises the fear of those who have been stigmatized or
about to be get one. It has led afflicted persons to fill they are unemployable
while those with employments live in constant fear about being found out. Those lucky
enough to have some employment security are often stereotyped into
simple menial jobs that are often not commensurate with their education or
skills. Among them, only a third actively sought out professional medical help.
It has been estimated that in general, one in 10 of these
mentally-ill individuals are treated with some form of
medication or counseling (Whalen, 2006). This applies to both civilian
personal in commercial and industrial firms as well as service members in the
US military.

A military
commissioned report: Army: Health
Promotion, Risk Reduction, Suicide Prevention (US Army, 2010) showed a
dramatic increase in the number of recent cases of post-traumatic stress
disorder (PTSD), from 2,931 in 2004 to 10,137 in 2007. What was more disturbing
was the increase in suicide deaths among service members with PTSD, from 4.6%
in 2005 to 14.1% in 2009. Despite this
high prevalence of mental health issues, 87% of active duty service members did
not seek care at 12 months after returning from war due mostly to an aversion
to acquiring the societal stigma associated with mental illness (Kim, Thomas,
Wilk, Castro, & Hoge, 2010).

The gold
book (US Army, 2012, p. 69)) adopts the American-heritage dictionary definition
of stigma as a “mark of shame or discredit.”Stigma is seen as a barrier to care (Hooyer, 2012), adversely influencing
the decision to seek psychological help among military personnel when suffering
from mental health problems.No less
than the US military recognizes the problem as documented in its Red Book (US
Army 2010, p33) when it stated that “stigma continues to be the biggest
deterrent to seeking help. Although help-seeking behavior is increasing in the
Army, many still believe that seeking behavioral health counseling would
negatively impact their careers.”

A
cross-sectional study was done by Kim et al (2010) surveying 10,386 active
service members of the National Guard known to suffer from some mental health
problems 3-12 months after a combat duty in Iraq.This study concluded that active duty service
members with mental health problems had significantly lower rates of service
utilization with significantly strong feelings of stigma and barriers to
care.The study recommended improvements
to the care of veterans towards addressing the stigma associated with receiving
mental health care. Despite the high prevalence of mental issues reported among
service members returning home from combat duty in Iraq and Afghanistan,
research has shown that only around 50% of these psychologically “damaged”
service members reported getting the proper mental health counseling within a
year of returning (Hoge, Auchterlonie, & Milliken, 2006; Hoerster, Malte, Imel,
Ahmad, Hunt, & Jakupak, 2012).Hoerster et al (2012) in a recent
survey among US veterans of the Iran and Afghanistan wars pointed to perceived
stigma as a barrier health care among service members afflicted with depression
and PTSD as well as consequential alcohol abuse as impediments to seeking
psychiatric help.The study recommended
unconditionally that the US military should target war veterans diagnosed with
mental illness in a comprehensive outreach program to ensure wider coverage.

The low mental health care service
utilization was due to stigma and perceived barriers to care. Hoge et al (2006)
found that military personnel who met the screening thresholds for the mentally
problematic reported feelings of stigma. Research on stigma in civilian
populations asserts that stigmatized individuals who have internalized the
social perception have lower self-esteem (Whalen, 2006; Crocker & Major, 1989)
with many likely to be averse to treatment.In the military, stigma is defined in the Gold Book and Red Book as “the
perception among leaders and service members that help- seeking behavior will
either be detrimental to their career… or that it will reduce their social status
among their peers” (US Army, 2012, pp. 69, 72; US Army, 2010, Stigma in
Glossary).

Hoge et al
(2004) revealed that service members’ own perceptions about PTSD, depression,
and anxiety, were signs of psychological weakness and were the main barrier to seeking
medical care. Hooyer (2012) showed that stigmatized service members suffer from
discrimination within the military hierarchy which included the physicians
assigned to treat them. PTSD has been stereotyped as a disease that turns
otherwise competent service members into mentally disabled and unproductive
service members. This stereotype revolves around the concerned soldier who
attempts to get out of service and collect compensation, creating a second
layer of stigmatization, the first being the stigma linked to seeking
help.The afflicted soldier is now
burdened to prove that his mental disorder is real and goes beyond the
diagnosis by publicly displaying behavior consistent with the diagnosis. If
this succeeds, the service member is seen by his peers and society as unfit in
the military, but if it fails, as a fraud. Either way, the service member
losses the battle to regain whatever self-worth he or she had.

Researchers have revealed that stigma
creates added stress that further erodes an already diminished quality of life
for the mentally ill person (Couture & Penn, 2003).

It is for
this singular reason that researchers have sought intervention methods for
reducing stigma. One strategy espoused by Couture and Penn (2003) in this
direction is a purposive interpersonal communication with mentally ill people and
their families who can help in the process. Research shows that both
retrospective and prospective contact tends to reduce stigmatizing views of
persons with a mental illness. Several
groups have championed various initiatives to reduce stigma and provide a more
open atmosphere for mentally-ill people to obtain the needed professional
attention.Whalen (2006) mentioned the
Canadian Mental Health Association (CMHA) as sponsoring a program called Stereotypes,
Trivializes, Offends, Patronizes (S.T.O.P) to significantly reduce the stigma
among Canadian citizens suffering from mental illness.Its vehicle is a comprehensive educational
campaign aimed at the youth sector based on studies that it is relatively
easier to de-stigmatize mental illness among the youths than adults.Sartorius and Schulze (2005) discussed one
such initiative with a global reach from a concerted program headed and guided
by World Psychiatric Association and participated by several countries like
Greece, Germany, Sweden, India, Spain, Nigeria, Uganda, United States, and United
Kingdom.

People generally have wide latitudes
to respond to stressful stimuli, whether at work or at home. Conceptualizing
stigma as a form of stress can provide significantly wider options for coping
mechanisms that allow stigmatized people to overcome the societal prejudices
associated with the stigma (Miller & Kaiser, 2001). A stigma is not a
disease, but just a label that has profound effect only if the labelled person
takes it seriously enough to adversely affect how he or she deals with everyday
situations. Ignoring the label may sound easy, but this requires courage to go
against social normative perceptions. Stigmatized people are generally aware of
their devalued worth in the society they live in (Crocker, et al, 1998).It is a tribute to these people that many of
them have learned to cope with the double jeopardy presented by both the
illness and the stigma. Several theoretical models over the last three decades
have attempted to explain the behaviour and psychology of people suffering from
social stigma (Hansen, 2001).One such
theoretical model that this paper will use to provide the contextual framework
is explained the next section.

This study
takes on the devaluation theory of Crocker and Major (1989) who posited that
people who have been stigmatized devalue or de-emphasize those dimensions in
which they are perceived to be perform poorly.This effectively a denial coping mechanism by which stigmatizes people
who are themselves devalued in the eyes of society attempt to maintain their
self-esteem. A clear instance is when Afro-American students in all levels have
consistently measured poorly in Scholastic Aptitude Tests (SAT) and other
academic performance tests compared to their Asian and White counterparts (Chapman,
Laird, & Ramani, 2010; Borman & Rachuba, 2001).This psychological disengagement rationalizes
these comparative failures that comfort many African Americans with the
self-serving notion that these tests do not reliably measure their worth. Consequently,
they de-emphasize academics and the associated performance measures (Schmader, Major, & Gramzow, 2001)
since, if one cannot excel or do well repeatedly in one area, it is possible
there is an inherent absence of opportunity or a persistent bias.Why bother recognizing it if it poses a
threat to one’s pride or self-esteem? The drawback to this coping theory is that
devaluing an important societal dimension may lead to economic, socio-political,
or cultural displacement or harm and further justify the misimpression by those
who would stigmatize them.Perhaps more
insidiously, the same devaluation could further hinder the stigmatized from
improving on what causes the stigma.However,
this drawback could be an advantage when the stigmatized devalues a
misconception and rises above unfounded stigma, such as in the case of stigma
associated with mental illness.

Mental Illness.The term is often interchangeably used with
“mental disorder.”The National Alliance
on Mental Illness (NAMI, n.d. para. 1) defines it as a “medical condition that
disrupts a person’s thinking, feeling, mood, ability to relate to others and
daily function […] (and) result(s) in a diminished capacity for coping with the
ordinary demands of life.”The same site
categorizes major depression and post-traumatic stress disorder (PTSD) as among
the forms of mental illnesses.

Post-Traumatic Stress
Disorder (PTSD).This is a
behavioral or mental ailment arising from a failure to cope with a traumatic
event which Yehuda (2002) characterize as a situation that provokes fear,
creates a feeling of helplessness, or horror in response to the threat of
injury or death.

Psychologist. The
occupation is clinically defined as a healthcare professional who specializes in
“diagnosing and treating diseases of the brain, emotional disturbance, and
behavior problems” (Medicine, 2000, para. 1).Armed with either a doctoral degree (Ph.D.) or a master’s degree (MA) in
psychology, Psychologists use conversational therapy in treating their
patients, and cannot prescribe medication which only a Psychiatrist can do.

Psychiatrist.NAMI (20120, para. 1) defines the profession
as a “physician who specializes in the prevention, diagnosis, and treatment of
mental illness.” Like any doctor, a
psychiatrist may undergo additional training to specialize in such areas as neuropsychiatry,
addiction psychiatry, and child psychiatry, to mention some. Unlike
psychologists, psychiatrists can prescribe medication.

Stigma.Stigma is basically an opinion or judgement labeled
or branded to an individual by other people or the society at large. The
implications to the label are negative, often associated with disgrace or shame
that is regarded by most members of the community as socially unacceptable
(Aidsmap, 2012).The labeling devalues
the stigmatized person in the eyes of others. Only a very thin border separates it from
outright discrimination.Once the stigma
elicits an action from someone, the action can be considered as discriminatory.

The study
aims to answer the question: Among active military personnel, does being
publicly known as or seen to be a mental health patient stigmatize them in the eyes
of society? The study explores the
nature and extent of the stigma that has affected their lives, if at all, as a
patient and soldier in private and in public.

The study
posits the hypothesis that military personnel publicly known as or seen to be a
mental health patient are socially stigmatized that has adversely affected
their private lives as a patient and while still on active duty. Stated
differently, this stigmatization resulting from having had consultations with a
psychiatrist or mental health care practitioner has adverse effects in how
service members deal with the daily challenges presented in both their work and
private lives.

The
independent variable in the study is the frequency with which military
personnel is seen by the community or by those around him to have consulted
with or being treated for mental illness.Subjectively, the level of stigma can be gauged by the air of negativity
as perceived by the soldiers when dealing with their peers or members of their
communities.This is measured in the
paper as the dependent variable.

The
population which the study will sample for its primary data collection consists
of US military personnel in the armed forces stationed on a local military base.They are currently in active duty with some
having had exposures in the latest wars in Afghanistan and Iraq.There is no question that military personal
suffering from depression or dealing with stress resulting from some stressful
or traumatic experience require serious medical attention if the US fighting
force is expected to do a competent job should they have to rise to the
call.

As explored
in the literature review section, there have been several studies in the last
decade revealing the psychological damage to several military personnel in the
US and the UK as a result of their engagement in the Iraq and Afghan wars.Crocker et al (1998) have complained that our
understanding of stigma remains weak and further research from as many angles
of how it originates the better to eliminate the social stigmatizing forces in
society as well as research into the affective and cognitive consequences of
coping with the stigma.Most of these
research works have taken place in controlled laboratories to ensure high
internal validity of results, but what is needed is a more naturalistic research
using qualitative assessments in as wide a sample base as possible to ensure
close modeling of real-world experiences of stigmatized people (Hansen, 2001). This study uses this approach but focused on
US military personnel on active duty.

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About Me

Semi-retired since 2009 and now working as a freelance photo editor/colorist and online writer. Started out as an avionics mechanic at Philippine Airlines, transferred to its Marketing and IT departments before becoming the MIS head for Citadel Holdings. Then went on to become BPO Mobilization Manager at Accenture and finally Business Development Director at an Ads agency.